HCA uses the TQ to gather information for this purpose. If the completed medical treatment did not relate to an accident or incident, please explain in section A on the front of the form and section D on the back of the form. If there was an accident, but no one else caused it, complete the form with the circumstances explained in detail in section D.
Visit our Benefits and services webpage to learn more about Apple Health coverage. HCA can only accept checks for our subrogation balance. Those checks will be returned to your office for reprocessing. Medicaid is not an insurance company or employee benefits plan, so will not respond to requests for ERISA plan documents. The agency is not required to or able to provide "plan" documents under 29 U.
Skip to main content. Administrative Disaster outreach. Fraud prevention. Gender identity information. Legislative relations. Medicaid program integrity. Activities and oversight. Contact us. Public disclosure requests. Voter registration. Personal injury, casualty recoveries, and special needs trusts. What information do I include? Social security number Date of birth Date of injury City and county where injury occurred Details of the injuries sustained by our recipient Source of accident i.
Has the client completed treatment? Where do I send my letter of representation? Help us help you! To ensure a quick response: Include only one client per request. Send only one copy of your materials. Use only one method for delivery. When will my request be reviewed? What happens before I send a check? After we receive the settlement documentation, we calculate the final amount due by completing a Medicaid Payment Worksheet MPW. Settlement documentation: Per RCW Copy of your fee agreement and the actual fee charged.
Itemized statement of costs: If more than one claimant settled, identify which costs are related solely to our Medicaid client, and which are joint costs. Identify costs related to the settling defendant s. Send these documents to the assigned case manager directly via email or fax to We will send a copy of the complete MPW to your office as soon as possible.
This MPW is your invoice and includes all of the payment instructions needed. What if my client is under 65? If your client is under 65, we will need to know: If a special needs trust has been or will be established , or If the funds were or will be dispersed to the client directly. Recovering your deductible If you paid a deductible, your company must include your deductible in its subrogation demand to the at-fault party.
See also What to expect when you file an auto insurance claim Filing a homeowner insurance claim. Need more help?
Call us at , 8 a. Requesting an administrative hearing. Scope of care. Social Security Number. Statement of Hmong or Highland Lao Tribal membership. Third Party Liability. Time to process. Who can apply for whom. Revised Date:. December 5, WAC Assignment of rights and cooperation. Effective January 27, When you become eligible for any of the agency's health care programs, you assign certain rights to the state of Washington.
You assign all rights to any type of coverage or payment for health care that comes from: A court order; An administrative agency order; or Any third-party benefits or payment obligations for medical care which are the result of subrogation or contract see WAC When you sign the application you assign the rights described in subsection 1 of this section to the state for: Yourself; and Any eligible person for whom you can legally make such assignment.
You must cooperate with us in identifying, using or collecting third-party benefits. If you do not cooperate, your health care coverage may end unless you can show good reason not to cooperate with us. Examples of good reason include, but are not limited to: Your reasonable belief that cooperating with us would result in serious physical or emotional harm to you, a child in your care, or a child related to you; and Your being incapacitated without the ability to cooperate with us.
Your WAH coverage will not end due solely to the noncooperation of any third party. You will have to pay for your health care services if you: Received and kept the third-party payment for those services; or Refused to give to the provider of care your legal signature on insurance forms.
The state is limited to the recovery of its own costs for health care costs paid on behalf of a recipient of health care coverage. The legal term which describes the method by which the state acquires the rights of a person for whom the state has paid costs is called subrogation.
Clarifying Information When another party a third party has been identified as responsible for payment of a health care expense, Apple Health does not pay the health care claim until after the third party has paid. Write "For Information Only" on top of the HCA and send to DMS when the only medical resource is: Accident case with potential liability auto, medical malpractice, homeowners ; Labor and Industries coverage of an injury; Crime Victim and Victim Assistance involvement; or Products liability potential coverage.
Payment of Private Health Insurance: The Health Care Authority offers a Premium payment program for people who have been determined eligible for Apple Health, and have private health insurance including individual policies, COBRA policies, and employer-sponsored plans.
All applicants for the premium payment program must first have been approved for free Apple Health coverage. Contact a Premium Payment Program specialist at , ext. Please report broken links or content problems.
0コメント